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Fabio Lavinsky, Joel S Schuman, Katie A. Lucy, Mengling Liu, Youngseok Song, Hiroshi Ishikawa, Gadi Wollstein; Can Macula and Optic Nerve Head Parameters Detect Glaucoma Progression in Eyes with Advanced Circumpapillary Retinal Nerve Fiber Layer Damage?. Invest. Ophthalmol. Vis. Sci. 2017;58(8):697.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the ability of OCT optic nerve head (ONH) and macular parameters to detect disease progression in eyes with advanced glaucoma, including those reaching the practical minimal possible thickness measurements (floor effect).
Subjects with advanced glaucoma with ≥ 4 visits, at least 5 months apart, with Swedish interactive thresholding algorithm 24-2 perimetry (SITA standard; Humphrey Field Analyzer; Zeiss) and spectral-domain OCT (Cirrus HD-OCT; Zeiss) were enrolled. Advanced glaucoma was defined as OCT average circumpapillary retinal nerve fiber layer (cRNFL) ≤60µm. The OCT measurements that were analyzed were average cRNFL, macular ganglion cell inner plexiform layer thickness (GCIPL), vertical C/D ratio and average C/D ratio, rim area and cup volume. The rate of change of each parameter was computed using a linear mixed effect model (LME) accounting for baseline age, gender and signal strength.
Forty-nine eyes (41 subjects) qualified for the study. The average age at baseline was 67 years (range 44-87) and the mean follow-up duration was 40.1 months. At baseline, subjects presented with visual field mean deviation (MD) of -11.38± 6.06dB and cRNFL of 55.20±3.60 μm. The rate of change for MD over the course of follow-up, while accounting for age at baseline and gender only, was statistically significant (-0.452 dB/yr (p=0.01)). In the same follow-up period, cRNFL rate of change was not significant (0.047 μm/yr, p=0.743), while OCT parameters demonstrated a significant rate of change: GCIPL=-0.504 μm/yr (p<0.001); cup volume=0.006 mm3/yr (p<0.001); rim area=-0.012 mm2/yr (p<0.001); vertical C/D ratio=0.006/yr (p<0.001); average C/D ratio=0.005/yr (p<0.001). Age, gender and signal strength were not significant in any of the models.
Macula and ONH parameters might be useful in following subjects with advanced glaucoma reaching the floor effect of cRNFL measurements.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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